If you lift long enough, you’ll probably encounter some sort of shoulder pain. There are a million different reasons why you might feel a pinch when pressing overhead, feel tight and restricted while swinging your arms around or just feel weak in certain shoulder positions. Each situation is different, and there’s no advice I could give on this blog that can cure everyone. But what I can do, is give you a fighting chance to feel better. This article outlines main areas that someone dealing with chronic shoulder pain can work to improve. This article is written for the person that has chronically problematic shoulders. If you have ever been tempted to take a few Advil before and after your lift, this is probably for you. If you do a ton of overhead pressing with little regard to the consequences, this is also for you (I’m looking at you, Crossfitters!).[** Note: if you are in severe pain or think there’s even a chance you did something serious to your shoulder, stop reading and go call your Doctor! I once acutely tore my shoulder labrum, and nothing but immediate medical attention was going to help.]
Anyway, here are a few of the most common causes of shoulder issues:
- poor joint position (internally rotated shoulders)
- poor bone structure (external/subacromial impingement)
- poor scapular mechanics
- restricted tissues
- muscular weakness
- soft tissue damage (torn muscle / cartilage)
- prior injury history
What many people fail to grasp is that there is rarely ONE underlying cause to their shoulder problem. It is rarely JUST a mobility issue, rarely JUST a strength/stability issue, rarely JUST a motor pattern problem. Everything is interrelated, so no one thing is the secret to improving. In order to make progress, I recommend spending time working on ALL of these qualities.
1. Joint Position / Mobility
2. Movement Quality / Motor Control
3. Muscular Strength / Stability
4. Tissue Quality
I also urge you to stop ALL exercises that cause pain or irritation before diving into a shoulder rehab protocol. That probably means no overhead pressing, no kipping movements, and using some caution when it comes to bench or dip movements. My rule is always: “if it hurts don’t do it!”
1a. Joint Position -Shoulder
You want the head of your humerus centered in the glenohumeral (shoulder) joint. If you walk around with your shoulders slumped forward, chances are this is contributing to your pain. Sometimes you need to “reset” shoulder position after a long day of sitting in front of a computer, or due to lack of balance in your training. Always look to joint position first! Taking care of this aspect can solve a lot of other related problems. Your joint position may be off because:
- You have poor sitting posture (shoulders rounded forward)
- You have tight internal rotators (pecs, lats, teres major, subscapularis)
We will fix this problems with three tools: a jump stretch band, a kettlebell, and a foam roller/lax ball.
The banded bully is one of my favorite exercises to stretch the shoulder. I first came across it in Kelly Starrett’s Becoming a Supple Leopard. Sitting and driving all day can make your shoulder posture look rolled over or slumped. We can’t expect that to lead to positive adaptations. This move will reset your shoulder back to neutral. Place a stretch band over a pull up bar, and slip the other end over your shoulder. Keep your back neutral, and then lean forward. Don’t forget to squeeze the glutes and brace the core – this also goes for the rest of the movements in this article. Press the top of your hand into your lower back. Hold the position for at least 30 seconds before switching sides.
This is another great exercise to emphasize proper shoulder position. Use a weight that is heavy enough to push your shoulder down into its socket. For an added benefit, slowly rotate back and forth to either regain or maintain rotational capacity of your shoulder. People who complain of shoulder pain during bench presses sometimes lack internal rotation, so this exercise might clear that up.
1b. Joint Mobility – Thoracic Spine
Close in proximity to the glenohumeral joint is the thoracic spine. Many people lack adequate mobility (extension and rotation) in the T-spine, so they have no choice but to have ugly shoulder positioning. Simply put, you need thoracic spine mobility to give your scapulae enough space to move without impinging the GH joint. There are a lot of moving parts required to get your arm above your shoulder, and if any one of them doesn’t have the range of motion required to get the job done, you will be hurting. Your body will find a way to get your arm above your head by compensating in another area, possibly creating problems in other parts of your shoulder.
Quadruped Thoracic Extension + Rotation
Going with the theme of “sitting ruins everything,” modern day life has turned our once mobile upper backs into something more resembling a concrete slab. My favorite thoracic spine mobilization is the quadrped (on all fours) extension + rotation. Start by placing your fingers by your ear, like Hulk Hogan in his prime.
Then slowly rotate through your upper back and touch your elbow to your other elbow. Rotate back up, making sure to look up through your elbow.
Another exercise used to restore thoracic function is the bench mobilization. This emphasizes thoracic extension more than the last exercise. This one also adds shoulder flexion. Grab a PVC pipe and line up in front of a bench. Kneel down and then put your elbows onto the bench. Push your hips back towards your feet, and at the same time, push your chest toward the floor. You should feel a stretch in your triceps, as well as in your shoulders and upper back.
2. Movement Quality / Motor Control
Your shoulder issues could be traced back to poor mechanics. You may have developed a bad pressing pattern, or you just don’t know how to correctly control your scapula (shoulder blade). Either way, this focus will be on learning how to move better.
Scapular movement required for sound overhead pressing:
- posterior tilt
- upward rotation
Knowing what is required of your shoulder blade, do these exercises to train the movements:
Prone 1 Arm Trap Raise
This is a great exercise to target the lower traps, while helping reestablish scapular upward rotation and posterior tilt necessary for healthy overhead mechanics. Lay prone on a bench. Have one arm hanging off. Wrap your other arm around the post of the bench for support. Have your chin supported by the end of the bench. Raise your working arm diagonally. From above, your arm should form a half “Y”. Make sure to keep your arm straight. To ensure that you are correctly tilting your scapular, imagine that you have a spotter than needs to swipe his hand underneath your shoulder. If you don’t tilt, his hand would not fit.
3. Muscular Strength / Stability
You may have imbalances between muscle groups. Your perceived muscular “tightness” could even be a protective mechanism for a muscle that isn’t functioning properly (lack of stability). Take a sledgehammer approach to this issue.
We will work on:
- rotator cuff stabilization
- scapular retraction strength
- shoulder abduction
This is a great upper back exercise to strengthen the rhomboids and traps while promoting better posture, proper shoulder mechanics, and scapular control. Set up up a plank position. Lower your chest to the ground, squeezing your shoulder blades together. Then raise yourself up back to the start position, making sure to bring your shoulder blades back to neutral.
Band Pull Aparts
This exercise is an open chain movement that works all the scapular muscles. This movement has more inherent instability because your arms/hands are not fixed on the ground. This will hit the deltoids and part of the rotator cuff, as well as the rhomboids and traps. Get a band that isn’t too thick. Hold it out away from your body, with your arms both straight. Retract your shoulder blades while pulling the band apart. To add a further challenge, you can pull apart diagonally.
This exercise emphasizes rotator cuff stability. You are training your shoulder stabilizers to fire correctly. Start out with a very light kettlebell, use your off hand to put the KB in position. Keep your core tight. Make sure your elbow is slightly below your shoulder, and your humerus (upper arm) is at a 90 degree angle relative to your torso. Also, the kettlebell should be directly stacked above your forearm. Squeeze the KB as hard as possible.
- Progression – KB March – walk around with the KB while holding it. The KB will start moving side to side, forcing your cuff to work hard to stabilize
4. Tissue Quality
Work on tissue quality. Every day. Self Myofascial Release (or “SMR” is just a fancy term for self massage- foam rolling is a common form) causes muscles to relax. A good SMR session can also release trigger spots and improve the ability of your tissues to slide freely. A restricted tissue is a potentially painful tissue. Several tips:
- Take your time, and slow down even further on a hot spot.
- Employ the “contract relax” technique. Squeeze the muscle you are working on, and then relax to try to sink even deeper. Some painful parts of the muscle are not near the surface. Get in deep!
- Roll on various implements – foam roller, PVC pipe, lacrosse ball and softball. Each item is better suited for different body parts. For the shoulders – stick to the roller for the thoracic spine, the softball for the upper back and lats, and the lacrosse ball for the deltoids and the rotator cuff.
Transitioning Back to Overhead
A great tool to progress back to overhead movements is the landmine press. The nature of the landmine means you can press at a lesser angle and still work the shoulder musculature. The landmine press is also an excellent option for someone that is susceptible to impingement. You can get a solid training effect without forcing a motion that your body wasn’t designed for. If you don’t have a landmine, just put a barbell in the corner. I personally own the Rogue Post Landmine, and I think it is a very underrated training tool.
After passing the Cressey Shoulder Flexion test (as outlined below) pain free, you can then enter shoulder maintenance mode. I recommend paying extra attention during your warm-up before an upper body lift, or and Olympic lifting session.
- Break a sweat (jump rope, jog, do a bunch of squats, etc)
- Roll pecs, lats, and upper back
- Banded Bully, 30 sec each side, x 2
- Quadruped extension rotation, 10x each side
- Band Pull Aparts- horizontal x10, diagonal x10 each side
- Shoulder Flexion Test, x10
- Upside down KB March, x10 steps each side
- Yoga Push Ups, x10
Don’t Forget to Assess!
To establish a baseline of your shoulder range of motion, do this test recommended by shoulder specialist Eric Cressey:
Shoulder problems can be tricky. With the right approach, many problems with underlying mechanical, positional, or stability causes can be not only addressed, but eliminated.
Mulligan Fitness and Hylete.com
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